Healthcare Provider Details

I. General information

NPI: 1578220943
Provider Name (Legal Business Name): TRAUMA THERAPY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2021
Last Update Date: 11/20/2021
Certification Date: 11/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 N ROGERS LN STE 121
RALEIGH NC
27610-6083
US

IV. Provider business mailing address

1030 N ROGERS LN STE 121
RALEIGH NC
27610-6083
US

V. Phone/Fax

Practice location:
  • Phone: 843-732-9340
  • Fax:
Mailing address:
  • Phone: 843-732-9340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number
License Number State

VIII. Authorized Official

Name: DIANA ANZALDUA
Title or Position: CEO
Credential: LCSW
Phone: 843-732-9340